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Tuesday, November 8, 2011

We are all just doing our best to be better runners. That means different things to different people. Some want to be faster. Some want to remain uninjured and run pain free. Some want to lose weight or maintain weight loss. Whatever your goal, if you are committed to your running, you’ll go to great lengths to be able to do it and do it well.

I want to improve. Sure, I want faster times, but I simply want to be a healthier runner. I want to remain injury-free, I want to see progress, I want to feel good when I run. Like I did here –>

As you know, I’ve had this nagging ass issue. It started long before my injury, and probably led to my downfall. It subsided for awhile but “reared” (get it?) it’s ugly head once I added mileage and racing again. The pain recently moved down to my higher hamstring.

I will say that one year ago I was on crutches with a hip stress fracture. Since that time, I have done 3 triathlons (one of them a 70.3), one marathon (Boston), and 2 half marathons. All of these were pain free with the exception of one (my last race in October). That said, I know my running performance was off. I never felt quite right. I knew I was compromised.

Like most injured athletes I am grasping. What is the best treatment? Is it expensive? How long until I am cured? What are the root causes of my problems and how do I “fix” them?

There are two things I know for certain that I need to address to get to the root cause:

These two things will take time. I am committed and willing to do what it takes. I am 44 and have only been running for 3 years. I have a lifetime of running head of me. I have a lot I want to do.

In the meantime, however, I am also looking to deal with where I am today. Enter, Matt Schaub, LMT with Handled with Care Massage:

Matt contacted me (One of his clients, my friend, gave him my name. She said he “changed her running life.”). He offered a complimentary trial session in exchange for an unbiased review on my blog. He uses an active release technique that involves finding the trigger points and applying pressure to the impacted muscle. The muscle is then put through both active and passive stretches, releasing the adhesions in the tissue(s).

Make sense? Basically, intense pressure is applied, you cry and try not to fart and then stretch and resist. Things should release, but hopefully not your sphincter.

Poor Matt. I made him take my picture. That’s what we bloggers do. Damn I have boney back.

I told Matt that the pain had started in my glutes over a year ago, but more recently hit my hamstring. He started putting pressure on the piriformis (think left butt cheek) and this was extremely tender, so he was hitting the right area. Matt was able to release my tight piriformis muscle using what is known as an active release technique. He then did the same with my glute minimus, which has also been source of pain and discomfort for some time. The deep massage also brings increased blood flow to the area, which helps with healing.

I’m not going to lie. This hurt like a mother. I have had many deep tissue massages (I even had some woman walk on me once, almost broke my sternum), but nothing compares to the depth that Matt achieved today. I am one of these people, like John Cougar Mellencamp, who enjoys the pressure and the “good hurt” and I let him to know to not take it easy on me. Yeah, he didn’t and it was intense. I loved it.

Matt talked to me a lot about trigger points. In layman’s terms, you have muscles that are trigger points. When they are compromised, they refer pain to other parts of your body. That’s why many times when you feel pain in one place, that is not actually the source of the problem. “The trigger point model states that unexplained pain frequently radiates from these points of local tenderness to broader areas, sometimes distant from the trigger point itself.” {source}

Guess what? The piriformis and glute minimus are trigger points for the hamstring.

The result of the massage? I don’t know yet. My ass feels looser than it has in a long time (probably not a good thing for someone like me – haha!). Matt said when he started things were very cramped up, knotted and tight. He was confident that he released and broke up a lot of stuff. Our plan is that I run on Thursday and see how I do. I’m excited because he believes that we will see very good results in a just a few sessions. I will let you know!

Although I had a Cortisone shot last week in my high hamstring, I honestly am not convinced it did any good. Hard to know what is working when so many factors are at play. My guess is that for me it will be a combination of things, including lots of rest and smart training, that is key.

Matt makes it clear that he is client centered and results oriented. He zeros in on the root problem and tackles it with cautious intensity. And HE LISTENS. That part is sometimes quite hard to come by.

One of my most favorite things is that on the sheet he gives in the beginning, clients are encouraged to be comfortable whether that means yawning, moving around or letting out intestinal gas. PERMISSION!! HE GAVE PERMISSION TO FART!!

If you are in the Denver area and are looking for this type of results-oriented therapy, consider Matt. A one hour session is $65 and you can book online HERE. He is in Arvada on Ward Road.

Beth Thanks! My chiro has done some ART on me but this looks it might be just what I need! My @$$ seems better but I'm a little afraid to run again and find out. :( And the best part...he's way close to where I live!

Thank you for posting about this. I herniated a disc in my back while training for a half marathon back in 2008. When I resumed running again I noticed that my hips were sore. Fast forward to now and I'm again training for another half. My piriformis muscle is incredibly tight on my right side and often hurts (though not while running too much). I've resorted to using a tennis ball and sitting on it to apply pressure to the muscle. I'm out in CA but I might have to check out the active release technique. I hope it works and you feel better soon!

My husband did ART for his IT Band and it worked well for him. He also did stretch and strength exercises at the same time. My friends that didn't respond well to ART moved on to IMS - Intramuscular Stimulation. Apparently it hurts even more than ART, but works! However, there's a reason they refer to it as stabby-jabby...

I have had significant success with ART. Here, it seems like it's mostly done by chiropractors, as opposed to massage therapists. I had a calf issue that had been nagging me for months that was better right away and fixed (as far as I could tell) in 3-4 sessions.

I've also had good results with massage therapy by a therapist that does trigger point massage. I don't want a gentle relaxing massage when I go in. I want to feel it working.

ART is why I can run again :) Glad you found someone who seems to be getting you back to feeling good! And $65 for an hour? Shoot! It's $105 for 30 min out here in Expensiveland. I disagree with Katie...Graston is The Bomb. I even do it to myself with the handle of a butter knife!

Sciatica on both sides, a weird twisted vertebra that fused to my sacrum - maybe this type of thing might help. Right now I have a husband with a sharp elbow - sounds pretty similar - but a bit more professional might be what I need!

Thanks for breaking down the trigger points! I pretty much swear by massage therapy (and yoga/stretching), and I feel that when it's done effectively it can produce great results in your running. I get massages after every full/half marathon and have not had an injury yet.

Myofacial release and deep tissue massage is addressing and eliminating all of my pain, including some nasty piriformis pain that kept me up at night. I've had three sessions in the last month, and in that time I went from being able to run only 2-3 slow, uncomfortable miles to completing 6 fun, pain-free miles yesterday (I've been running less than a year.)

My problem is insanely tight muscles - not necessarily from running, but just from life. The massage, combined with the foam rolling and deep breathing/body scan/relaxing "homework" my therapist assigned me, has made a world of difference. I'm running looser, longer and faster. And I don't hurt. I have another session tomorrow and then I should be good for some time.

I've used ART for piriformis syndrome in the past and it worked great (as did switching to minimalist shoes). In fact, my massage therapist diagnosed it first, then was confirmed by a physical therapist.

Can Matt come to the ATL, pretty please with sugar on top??!!?? I'd gladly pay $65 to get my sciatica rubbed out. How awesome it is that you found an amazing LMT that will work with you in that area. I'm so jealous!!!! On a side note, I ran 14.5 yesterday, came home to find my aspaeris pivot shorts in the mail and threw them on. My LAC feels amazing today!! Ask Matt if he knows anyone in the metro-ATL.

I am really interested to hear how this works for you. I have not tried ART yet, but am experiencing the same pain in the arse problems that you have described. Right now I’m using the foam roller and tennis ball, but it’s not doing the trick. I hope it works for you!

Never had much luck with massage (perhaps haven't found the right therapist yet?), and haven't tried ART. But, as a poor and cheap PhD student, I fell in love with the tennis ball for self-massage. Somehow, I find it easier to inflict massage pain with an object other than my hands... So if I may make a suggestion: Grab a tennis ball and cozy up to a wall. Trap the tennis ball between the wall and your high butt (slightly below & behind your hip bone) and lean into the ball. Use your body weight to apply pressure, and wiggle around (side-to-side and up-down) to find the tender spots. When you find one, press it into the ball for 15 seconds, then release. Continue, repeat, both sides, etc. Bonus: You can do this with a glass of wine in your hand, while watching your evening TV shows. Just don't fall over. (Please.) Good luck, and hope your healing continues!

ART is fabulous for some superficial injuries. I've not found it helpful for a high hamstring tendonopathy. If the underlying cause is non inflammatory ( tendonopathyversus -itis) cortisone won't help either. Work on glute strength ( glute medius) and also adductor recruitment to keep the femur stable in the socket. I look at the deep 6 ( piriformis and friends) a bit like the rotator cuff. Those rotators ( deep 6) are overworking to stabilize the head of the femur. They are tiny suckers and yes they hurt when overused. Get the bigger glute mm to do their thing abducting and the adductors do their thing and the piriformis doesn't have to overwork.Ok blah blah blah. I would look at hamstring eccentrics as well. Lots of times the High hammy is overstretched and overworked bc it extends your hip bc the glutes are not doing their job.Hope this helps. Just remember the biomechanics need to change :) I think you know that!! Good luck!

Glad you took a chance with Matt!! Matt is definitely my go-to in the Denver area. Worth the drive from any where really! If I know I want to get something accomplished with my body whether it be aches, pains and/or mobility - I trust Matt fully to achieve the results I want and need. After breaking my neck and foot in a serious car accident two years ago, the best recovery and therapy (physically and mentally!) was spending time with Matt. As a triathlete, he is knowledgable and aware of how my injuries will impact my performance and recovery. Glad you got to visit him and I suggest others do the same.

OK, a couple of points here - great community, you sure are active readers and give a lot of feedback.

Holly who asked if once is enough - An analogy I like to use when people ask why they should come and see me when nothing hurts is that your body is like the engine in your car, it needs preventative maintenance to operate at optimal efficiency and output capacity. Do you only change the oil in your engine when the engine breaks, or do you get it done on a regular basis to prevent the engine from breaking? But once is better than never...

To Holly with the tennis ball....try a lacrosse ball. :)

To GoBigGreen - you are reading my mind. Adductor strength and hamstring eccentrics were already on the list to discuss next time. And I totally agree about the deep 6 - nearly always at least a factor in any hip/upper thigh dysfunction.

I'm undergoing ART now for an IT Band issue, and it seems to be helping (although it is slow). I go once a week, and tomorrow is week 3. You're right...it is not really "fun", but if it corrects the problem then it is worth it.

Since I'm going to run anyway (and I'll be hurting when I do so if I don't find a resolution for this), it is really just a question of where I experience the pain in the short term, and how long I endure the pain in the long run.

Best of luck to you on this...it doesn't work for everyone, but many claim excellent results.

I started seeing a chiro who is also trained in ART and Graston. He sot of bandaided me the week before my half (it was still a disaster) and then after the half started the real treatment. It took until the 5th treatment to really start seeing improvement (meaning I could run for more than 30 seconds before intense knee pain kicked in). I am slowly easing back into running and doing a lot of cross training. Today I did 3 intervals of 7 min run/3 min walk and then ran a mile. Three weeks ago, I literally couldn't run for 10 seconds without wanting to cry. I know part of it was just taking time off to rest, but I really believe in the ART and Graston methods.

I had to change my whole foot landing from a heel strike to a mid-foot landing (easiest way is with a low heel-drop shoe...traditional shoes have too much of a heel buildup and you end up not able to land on the forefoot as well). It was really hard to take 30 years of running and throw it out the window and relearn, but you will get the hang of it. Hope the ART works its miracle!!

Massage therapy, properly done, is amazing. I nearly cried both times when my therapists moved out of town, and jumped for joy last weekend when one moved back to Alberta. I will cheerfully arrange my schedule so she can come over. Yes, she brings her massage table here. It's wonderful to not have to drive afterward.

Getting regular massage is just as important as rest, or running, or eating. Or, to put it in terms SUAR is going to understand, as important as knowing where the nearest toilet is when the pressure is building.

I just had my first FREE ART treatment at the Del Mar Irongirl 5k! Lots of pain from PF in both feet. I too definitely need to add runner specific strength training to my workout. If ART weren't so expensive, I'd probably continue. Looking to see if the military docs can do it for me for free!

I have been going to ART (in San Diego) for a few weeks now; tomorrow will be my 7th session. I"m going for plantar fasciitis. I think it's helping, although I've developed new pains in different places now. Not sure if that's related to the ART or not. Regardless, I cry during each session as the pain is so intense (especially when she does my inner thigh). They are also working with me on correcting my running form.

Interesting information. I have been fighting a bit of a RAC problem (as opposed to your LAC) for a few months. I did get a couple massages, but they didn't do ART. Might have to look into finding someone.

I wish Matt was in Houston. I have done lots of massage therapy (deep, deep tissue) and it helps me. I have a really bad back, full of knots. When I get done, it's a good hurt and I feel better. After my car accident, I went to a Massage Therapist and she really helped my back. I'm interested to hear the results.

I have only had a couple massages in my entire life. However as I run longer distances and more life goes by, I am trying to use everything I can to help increase my ability to continue to run injury free (broken tail bone was not from running. It happend while sliding. So I am still running injury free so far) I need to find someone local who can do this! Sounds wonderful!I hope he had the magic touch for you.

My chiro uses ART. It has literally changed my life as far as running goes. I was having tons of knee/IT band issues. Between ART and the stretches and foam rolling techniques she showed me, I haven't had a single issue since April!

Hi! I sooo love your blog. So informative and funny!!I too am your age and have the "ass" injury. I have had to modify my gait as well. It has really helped but damn its hard to get use to that. I have been running for years and feel like my pelvis has been messed up ever since I had my daughter 3 years ago. Oh, the things we must deal with when aging.Hope your changes are helping you.

Funny you bring this up today because I was going to tell you to look into ART. I went to a new chiropractor today b/c of this nagging soreness in my right calf. He did ART to it and it feels 100x better already.

Of course he told me I'm as tight as a drum (TWHS) and so he gave me stretches to do before each workout and some to do after each workout as well.

I'll be going back for sure and I'm glad you found ART or BOB on your own!

I have the exact same left piriformis issue and it is gets most irritated with intervals and fast twitch while I can keep the tenderness at bay with slower running. I sit on a tennis ball after workouts and stretch and roll as well. I know how bad the massage hurts, but in my world, definitely helps. I might have to try out Matt as I am in a small town in WY.

I've had great luck with ART for piriformis and IT band issues. When I'm on the road (which is most of the time) and can't see a therapist, I use the trigger point ball and a foam roller and try to keep things in line with those, but nothing beats the ouch of a real session!

I've had 3 ART sessions for PF and it has helped. My PF is mild so I hope my foot heals 100%. Can anyone tell me.....does one with PF heal quicker with orthotics? I met a few runners at the RnR Savannah Marathon this weekend and they suggested getting orthotics to nip PF in the butt. Any thoughts would be greatly appreciated.

Obviously, a therapy like this is not going to be 100% successful for every person who tries it. Some injuries are more severe than others, are related to other problems or issues, or for some other reason it just doesn't work.Thanks for sharing

Sorry to hear about all of this, but you seem to have the right plan and attitude. I'm a person totally proactive I got some hard injuries but we don't give up because those are things that occur all time.

With my own participation and adventures in extreme sports competition, I have needed to be treated chiropractically myself. From knee and ankle sprains and back strains to finger dislocations and small broken bones, I have injured just about everything. Fortunately, my brother has been in practice for 35 years, knows my body well and is able to get me back in action when I need it.Click to get the services of Chiropractor For Shoulder Pain, Active Release Chiropractic and Denver Colorado Chiropractors